title: Musculoskeletal manifestations of neonatal nonketotic hyperglycinemia.
abstract: OBJECTIVE
  Neonatal nonketotic hyperglycinemia is an autosomal recessive inborn disorder of glycine metabolism in which large quantities of glycine accumulate in all body tissues. It is characterized by a progressive lethargy, hypotonia, myoclonic jerks, and early death secondary to respiratory problems. As a result of early diagnosis and treatment protocols, more patients survive the critical neonatal period with profound mental retardation, delayed developmental milestones, seizures, and spasticity. There are no reports about the orthopaedic manifestations of neonatal nonketotic hyperglycinemia. The purpose of this study is to evaluate the musculoskeletal findings of neonatal nonketotic hyperglycinemia.
  
  
  METHODS
  This is a retrospective IRB-approved study of all patients in our Orthopaedic and Genetics Clinics with the diagnosis of neonatal nonketotic hyperglycinemia during a 10-year period. Demographic, clinical, and imaging data were analyzed.
  
  
  RESULTS
  Twelve patients with neonatal nonketotic hyperglycinemia were evaluated, with a mean age of 7 years and 2 months (range: 5 months to 21 years). Seven were male and five were female. Eleven patients (92 %) have evidence of progressive early-onset neuromuscular scoliosis with a mean Cobb angle of 55° (range: 30-95°). Five children (42 %) presented evidence of progressive hip dislocation secondary to spasticity. All the patients have severe multiple joint contractures.
  
  
  CONCLUSIONS
  Neonatal nonketotic hyperglycinemia is a rare metabolic disorder presented in the past as a lethal condition. Recent advances in early diagnosis and neonatal care improve overall outcome. As pediatric orthopaedic surgeons, we need to establish treatment based on update information of the disease and probability to improve quality of life.
authors.affiliation: Pediatric Orthopedic Department, Mayagüez Medical Center, Box 6847, Mayagüez, PR 00681 USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Ramirez
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.forename: Francisco
authors.initials: F
authors.lastname: Casalduc
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rodriguez
authors.forename: Alberto S
authors.initials: AS
authors.lastname: Cornier
authors.forename: Simón
authors.initials: S
authors.lastname: Carlo
keywords: Hip dislocation; Joint contractures; Metabolic disorder; Scoliosis